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"According to the video, when faced with claims for identical
medical problems, Aetna separates the claims where no damages
are available - those subject to the federal Employee Retirement
Income Security Act, or ERISA - from non-ERISA claims, where
consumers can sue.1 2"
"ERISA was enacted in 1974 to protect the pension and welfare
benefits that employers provide their workers. It currently
covers about 2.5 million health plans and 125 million workers,
retirees, and dependents."
Employee Retirement Income Security Act (ERISA). Among other
things, ERISA provides protections for participants and
beneficiaries in employee benefit plans (participant
rights), including providing access to
plan information. Also, those individuals who manage plans
(and other fiduciaries) must meet certain standards of conduct
under the fiduciary responsibilities specified in the law."
Recent Federal Court Ruling in a Case with
$10,600 medical claim, insurance Co. refused to pay, provider
made numerous demand for payment in almost one year, but no
appeals filed, the court dismissed the lawsuit because provider
failed to exhaust administrative remedy, as required under ERISA,
by filing ERISAclaim appeals. This situation is so popular
in health-care community.
